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The Changing Faces of Obesity

From Wealth, to Beauty, to Disease


Obesity is a disease with major health implications and a current public health epidemic. However, its recognition as a medical illness dates back only to the current century, and a lot of work is still being undertaken to disseminate the concept of disease among policymakers and public health officials.

The perception of a “good” or “bad” weight was historically a matter of cultural norms and social implications, and the aesthetic impact of the body habitus remains a subject of concern and stigmatization.

Available figurines from prehistoric ages show women with increased corpulence. The Venus of Willendorf, as an example, considered as the Mother Goddess or the icon of fertility, is a sculpture showing an oversized woman. The Flemish artist Rubens portrayed beautiful women as those with a larger body size. Similarly, Renoir painted nude women with generous forms and sizes. Obesity was also shown in artistic representations of male figures, such as Pluto, the god of wealth in Greek mythology, and industrial barons in Renoir’s art. The association of corpulence with wealth, health and beauty stemmed at the time from the scarcity of food and increased famine. The presence of excess body fat was thus considered to be a sign of good social and cultural standing.

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Attitudes towards obesity changed over time with the agricultural and industrial evolution and the better availability of food. Slimmer female figures are seen in the work of artists such as Bouguereau.  Later in the 20th century, the representation of beauty became synonymous with slim figures. In the media, women and men were depicted as thinner and slenderer, with sometimes malnourished appearances. An example of this is the British model Twiggy, a teenage icon of the 60s, well known for her very thin physique. Twiggy set the stage for the super skinny models who came after her and were symbols of beauty and societal norm. In the latter half of the 20th century, the perception of corpulence not only changed but became the subject of stigmatization. Our current literature is full of examples of bullying and isolation resulting from socially undesirable bodyweight.

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In parallel with the cultural and societal implications of excess body weight, the medical and health significance of corpulence changed with time. While having some excess fat was considered medically acceptable initially, carrying extra weight was later perceived as a sign of bad behavior, as depicted by the 1905 book of Osler, who attributed obesity to the “vice” of overeating. Health consequences of increased body fat became progressively known to the medical community. In 1956, for example, the respiratory complications of obesity were described with the Pickwickian syndrome. However, the actual recognition of obesity as a medical disease with its own pathophysiology and health impact dates to the late 20th century, and more so to the current times. It was, in fact, only in 2013 that the American Medical Association, in concordance with all related medical specialties, officially named obesity as a “disease state”. And it was in 2015 that the first Obesity Day was introduced to increase public health awareness about the need to fight this rising epidemic.

Unlike other rising non-communicable diseases like diabetes and cardiovascular disease, obesity is a disease that can be seen. Herein lies both the advantage and the danger of this medical condition. Whereas a mild increase or excess in body fat is often directly recognizable to the individual and the physician which can lead to promptly initiating diagnosis and management, the obvious appearance of obesity may also result in intra- and inter-personal conflicts and the potential for social stigmatization. And herein lies our role as healthcare professionals. Rather than keeping weight to the dangers of social and cultural norms, our role is to increase awareness about obesity and to bring forward “healthy” weight as a desirable medical aim and obesity as a disease that can be treated, rather than a vice to be blamed or a social stigma.

Authored by Dr Maya Barake.


References:

  • Ferrucci L, Studenski S, Alley D, et al. Obesity in Aging and Art 2010 J Gerontol A Biol Sci Med Sci. 65A(1): 53-56
  • Eknoyan G. A History of Obesity, or How What Was Good Became Ugly and Then Bad 2006 Adv in Chronic Disease. 13(4): 421-427

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